Lansley needs to explain his reforms better

Erik Bluddax

Alas, it matters not a whit how much you explain anything to those that are not prepared to listen and comprehend, especially when most of those listening do not have the wit to understand.

Try looking at Fatbloke on tour's responses for some idea of the brick wall any attempt at reason comes up against.

Alex Gallagher

They didn't come out of the blue, as Lansley planned them for years. They did comemout of the blue because the coalition said there would be no top down reorganisation and they did come out of the blue to DC, who exprerssed surprise when Lansley told him about them.

As for the Marr interview, Lansley showed contempt for the professionals by implying that nobody who understood his changes opposed them (all the professional bodies do) and he showed contempt for the voters when he said ..."... "How many people have ever known what Primary Care Trusts mean?..."

WE know what it means and we don't want your changes Andrew....

Gawain

I agree with Erik. The explanation is simple. Things never stand still, we live in a world that changes relentlessly. Changes in technology and medical advances combined with the increasing costs of developing new medicines means that the NHS costs increase relentlessly. So you have two options, either you spend a vast amount more to meet these costs (and we don't have the money) or you make the NHS more efficient and you control the increase in costs. Simples, but no one will want to listen.

TrevorsDen

Correct Erik.

The govt are not tetchy enough with the BBC.

The NHS is far too complicated to explain. perhaps someone should point out the French health service is billions in debt.

normanc

As someone not against the reforms I have no idea how they are going to acheive anything. I think I know what they are meant to acheive (the old favourite that every reform is, greater efficiency?) but am not even too sure on that point.

As for the 'out of the blue' stuff, I think the problem is that before the election Cameron talked about how the NHS was a sacred cow, that spending on it would be protected, that it was the best system in the world, etc. and then he turned round and said 'actually it is second rate and needs reforming'. He later claimed second rate was a slip of the tongue and he meant second best but I don't really see the difference.

I think that's why people are upset at these reforms and regardless of what the reforms are and will acheive in most peoples minds they will always be opposed so I tihnk this one's a losing battle from the off.

charles hercock

The problem is that there is no logical explanation for the Lansley changes.

They have to keep wheeling out Dave(see the Times today) to support him and it is clear that Dave is struggling

They have not actually explained how they can reconcile the pre-election promise not to impose a top down change with what is going on.

Health is a minefield. As waiting lists build, as they are doing and patients are excluded from non life threatening operations, as they are being, they will only find the Coalition to blame.Remember well Neil Kinnock's speech "Her whole life clouded by pain"

In short by supporting and bolstering Lansley the coalition are ensuring defeat at the next election

It takes a strong leader to admit a major mistake

We will see how strong Dave is

echo34

Frankly, the more tetchy the coalition get with the w**kers at the beeb, the better.

Will J

1. Why give the budget to GPs rather than PCTs?
Because they are closer to the individual patient and so more likely to find optimal care for them.

2. Why make GPs join consortia?
Because on their own they would be too small for some key aspects of commissioning.

3. Why not have them all join one local consortium?
That would be little different to the status quo, where PCTs are like a single local consortium. The problem is that there is then basically only one buyer in each area. Flexible consortia create a number of local buying-groups from which GPs can choose, and on the basis of which individuals can choose their GP. Hence creating a functioning market.

Lonesome Dave

Lansley treated Marr with irritation, yes. Marr is clearly on an anti-coalition campaign looking for cheap headlines and verbal slip-ups. That's about his limit.

Odd how the Minister or Secretary of State is usually the early interview on the Marr show but the Shadowy spokesman grabs the main slot. Marr is not a good interviewer I'm afraid.

We need to treat them all, at the BBC, with the same degree of contempt and disdain as they continually treat us.

Rant over!

Mulli

Can supporters of Lansley's reforms explain how the changes will address the postcode lottery (that Cons have been banging on about for years) when they are actively fragmenting and federating commissioning bodies? There will be MORE health inequalities under this structure.

Magnolia

If you havn't got your health then it doesn't matter much what else you've got. Thats why health is such an important issue for voters.
The hospital doctors have been excluded from the commisioning process and they will be subject to competition. The most experienced ones who benefited from the good basic training of past decades will not be used by the private sector at all because they are locked in to a pay and pension structure that gives the most rewards during the final years. They also just get 'on with the job' of curing the sick because they have been locked out of management for some time and so called clinical managers are usually interfering obsessional greasy pole climbers who just want to lay down the last governments targets and layers of rules and regulation ie. they're rubbish and ineffective. Most medicine and surgery involves team work and there is usually a fight to the death going on between some members of every team. The truly inventive and open minded doc gave up on the system years ago.
I simply can't see the incentive to make the GP commissioning work for great chunks of hospital clinical care. The young consultants will leave the NHS in droves and then the private sector will offer care from a base of relatively inexperienced medics while the broken fossils try to hold it together until retirement back in the state sector. A few years ago my man was offered twice his NHS salery to go and work for a drug company. He declined, and the general population has benefited from his skills since and the main sticking point was the pension. We have contacts abroad and will have to weigh up the pros and cons of jumping ship at this late stage. Labour left booby traps in the hospitals because they introduced the age related increments in hospital doctor pay. It will not just sort itself out by magic.

PayDirt

So the GP's who now drive around in flash cars thanks to Labour's idiotic pay contract will be able to determine if my healthcare is within their budget? Sounds like a real crap deal. I do not need any new choice/marketing guff, I can go to a different GP now if I do not like the service. This NHS reform is just another reason not to vote Conservative next time round. I'm moderately happy with the NHS as it is, it was never going to be an easy task, it is open to all sorts of criticisms, however the great thing about it is that it is free of marketing junk which occupies more and more of our little lives as the modern world progresses. Simply a vote loser.

Yosemite Sam

Although these changes seem radical, and large, they are part of an evolution in the way the NHS is structured and worked that has been going on for more than thirty years, always in the same direction, and carried out by governments of all political stripes. The original structure was typical of nationalised industries established after the war. It consisted of Regional, and Area, planning and control bodies - the Health Authorities. In effect, these bodies implemented national directives locally. The idea of efficiency of operation, and patient choice or convenience was not considered. There was no systematic measurement of outcomes. The producers (whether professionals or ordinary workers) had some power depending on whether their wallets were being affected. The Conservatives first began to break up this monolith with fund-holding GP practices, and NHS Trust Hospitals. Labour at first went backward - abolishing fund-holding and restricting Trusts. However, very quickly, they realised this was folly. Without huge publicity or mandate they embarked on a radical remaking of the NHS which it now convenient to forget and was greater than Lansley's scheme. Regional and Area Health Authorities were abolished, as were Community Health Councils, all hosptials became Trusts, and PCT's were invented overnight (by Alan Milburn no less). Within months, hospitals were allowed to become virtually independent as Foundation Trusts, standard tariffs were introduced for procedures in hospitals, indepent surgical units were established on NHS sites, and (GP) practice based commissioning was required and established in all PCTs. PCT's had to divest themselves of provider services (mainly domiciliary services) and become commissioners only. Lansley's scheme is the logical next step. Practice Based Commissioning already exists. Why does it need the PCT structure to maintain it? There is already an internal market in the NHS at standard tariff level. Independent providers already operate within and for the NHS. As I say Lansley's proposals are the logical next step, they were in the Conservative Manifesto (p46) and they are not a top down reorganisation. They are an evolution. Political opposition is to be expected from the Labour hypocrits and opposition from the Unions, and Professional bodies ditto (they always oppose any change).

Mark Cannon

I heard a bit of Mr Lansley on PM a week or so ago. He had been on every day during the week and took listeners' questions on the Friday. He seemed to be doing a pretty good job. The proposals were set out very clearly in the Conservative Manifesto.

FF

TrevorsDen: The NHS is far too complicated to explain.

Quite. So we, the public, rely on the opinion of experts instead. Experts are substantially opposed to the proposed changes.

The Government needs to make the case to at least one of two groups: the general public, or the group of experts who can then add their seal of approval. In practice, I think that means the body of GPs.

cityboozer

Will J,

Exactly. Actually in this respect it's a little like the schools reforms - billed as creating a new supply of schools, they are in fact more likely to produce alternatives to LEAs than leave schools to run individually and independently.

Not exactly the ideal situation on the face of it, but still a zillion times better than what we have now.

Cb.

Alan P

@echo34

W*nkers like Andrew Neil, Nick Robinson and James Landale, that cabal of pinkos? Grow up

Left Footer - Right Wing

On the contrary. I thought Lansley handled Marr very well. Lansley has a good command of his brief but he is up against closed minds and in the current climate even basic rational discussions become blinded with politics. The inquiry into Stafford Hospital should be required reading for anyone wishing to participate in the health debate. Only then can you understand the importance of giving GP's and patients the opporunity to be able take their health care somewhere else.

Ian Walker

How to fix health:

1) Introduce co-payments.
2) Erm, that's it

crockhamtown

I thought Lansley did very well. No waffle. Very much on top of his brief. Gave credible and authorative explanations. Marr just gave up in the end. I learn't a lot. The only concern I have is if some doctors in a PCT area join and some don't. Who does the commissioning in those circumstances?

David Lindsay

With rail use at its highest since the 1920s, it would seem that public support for public services was increasing rather than decreasing.

Yet today, the party of Beveridge will assist in ramming through Parliament the dismantlement of the most valued of them all, the NHS, in England; in Scotland, Wales and Northern Ireland, they still get to live in somewhere that it is recognisably Britain, but here we are the guinea pigs in the never-ending crazy experiments of the think tank teenagers.

Whereas the creation of the NHS was in all three manifestos in 1945, this vandalism was in none of them in 2010, since no party with any such manifesto commitment could expect to win even one single, solitary seat. It over-flatters the Conservatives to accuse them of ideology here. This is happening for no reason expect to placate the people who funded their General Election campaign, and whom they want to keep the cash flowing.

If anyone is ideological about this, then it is the Orange Book Lib Dems. Oh, and the Blairite rump in the Labour Party. If David Miliband had become Leader, then this would have gone through on the nod, as most things did in the last Parliament, because no one stood up to demand a division on them. But thankfully, the Leader of the Opposition is not an Heir to Blair.

Woody

I don't think Andrew Lansley was tetchy, he was assertive and was going to stand no nonsense from Marr and about bloody time to.
I work in the NHS after previously working in the private sector and I can tell you this organisation desperately needs reforming. The number of useless managers and the billions they have wasted is criminal. Most would have been sacked in the private sector but it's a job for life.
Sadly it's some of these managers that are responsible for managing the reforms and I have to say that I wouldn't trust them to run a raffle.